Browsing by Author "Wabwire-Mangen, Fred"
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Item Age Differences in Sexual Partners and Risk of HIV-1 Infection in Rural Uganda(JAIDS Journal of Acquired Immune Deficiency Syndromes, 2003) Kelly, Robert J.; Gray, Ronald H.; Sewankambo, Nelson K.; Serwadda, David; Wabwire-Mangen, Fred; Lutalo, Tom; Wawer, Maria J.Gender differentials in HIV prevalence and incidence among adolescents and young adults have been observed in studies from Uganda (Fig. 1) (1–4) and other sub- Saharan Africa countries (5–7). Female adolescents are, on average, eight times more likely to be HIV infected than male adolescents. Biologic mechanisms such as immaturity of the reproductive tract in younger women may increase susceptibility to HIV acquisition, and social and cultural practices that promote early sexual activity among women may also be important. Another hypothesized factor is that young women are infected by having sex with older men, who may be more likely to be infected (8–10). This assumption is supported by comparison of age-adjusted HIV prevalence data (4,5,11) and mathematic modeling (12,13). Few empiric studies have examined the effect of age differences between partners on the risk of HIV infection in young women, however (2,14,15). We undertook observational analyses of the sexual behavior characteristics of adolescents in Rakai District, Uganda, to assess the extent to which the ageItem Age of male circumcision and risk of prevalent HIV infection in rural Uganda(Aids, 1999) Kelly, Robert; Kiwanuka, Noah; Wawer, Maria J.; Serwadda, David; Sewankambo, Nelson; Wabwire-Mangen, Fred; Li, Chuanjun; Konde-Lule, Joseph K.; Lutalo, Tom; Makumbi, Fred; Gray, Ronald H.Epidemiological evidence suggests that male circumcision may reduce the risk of sexually transmitted diseases (STD) and possibly HIV infection. Studies of STD clinic attenders have found that circumcised men are less likely to have gonorrhea, syphilis, herpes, candidiasis, and genital ulcer disease (GUD) [1–3]. Age at circumcision has also been reported as a risk factor in penile cancer [4]. Ecological studies report geographic correlations between HIV seroprevalence and the proportion of uncircumcised men in African populations [5,6], but subsequent cross-sectional and prospective studies found an inconsistent association between male circumcision and HIV-1 and HIV-2 infection in men and women [7–9].Item Agreement between Diagnoses of Childhood Lymphoma assigned in Uganda and by an International Reference Laboratory(Clinical epidemiology, 2012) Orem, Jackson; Sandin, Sven; Odida, Michael; Wabinga, Henry; Mbidde, Edward; Wabwire-Mangen, Fred; Meijer, Chris JLM; Middeldorp, Jaap M.; Weiderpass, ElisabeteCorrect diagnosis is key to appropriate treatment of cancer in children. However, diagnostic challenges are common in low-income and middle-income countries. The objective of the present study was to assess the agreement between a clinical diagnosis of childhood non- Hodgkin lymphoma (NHL) assigned in Uganda, a pathological diagnosis assigned in Uganda, and a pathological diagnosis assigned in The Netherlands. The study included children with suspected NHL referred to the Mulago National Referral Hospital, Kampala, Uganda, between 2004 and 2008. A clinical diagnosis was assigned at the Mulago National Referral Hospital, where tissue samples were also obtained. Hematoxylin and eosin-stained slides were used for histological diagnosis in Uganda, and were re-examined in a pathology laboratory in The Netherlands, where additional pathological, virological and serological testing was also carried out. Agreement between diagnostic sites was compared using kappa statistics.Item Alcohol consumption and risky sexual behavior in the fishing communities: evidence from two fish landing sites on Lake Victoria in Uganda(BMC Public Health, 2012) Tumwesigye, Nazarius M.; Atuyambe, Lynn; Wanyenze, Rhoda K.; Kibira, Simon P.S.; Liz, Qing; Wabwire-Mangen, Fred; Wagner, GlennThe fishing communities are among population groups that are most at risk of HIV infection, with some studies putting the HIV prevalence at 5 to 10 times higher than in the general population. Alcohol consumption has been identified as one of the major drivers of the sexual risk behaviour in the fishing communities. This paper investigates the relationship between alcohol consumption patterns and risky behaviour in two fishing communities on Lake Victoria. Methods: Face-to-face interviews were conducted among 303 men and 172 women at the fish landing sites; categorised into fishermen, traders of fish or fish products and other merchandise, and service providers such as casual labourers and waitresses in bars and hotels, including 12 female sexual workers. Stratified random sampling methodology was used to select study units. Multivariable analysis was conducted to assess independent relationship between alcohol consumption and sexual risky behaviour. Measures of alcohol consumption included the alcohol use disorder test score (AUDIT), having gotten drunk in previous 30 days, drinking at least 2 times a week while measures for risky behaviour included engaging in transactional sex, inconsistent condom use, having sex with non-regular partner and having multiple sexual partners. Results: The level of harmful use of alcohol in the two fishing communities was quite high as 62% of the male and 52% of the female drinkers had got drunk in previous 30 days. The level of risky sexual behaviour was equally high as 63% of the men and 59% of the women had unprotected sex at last sexual event. Of the 3 occupations fishermen had the highest levels of harmful use of alcohol and risky sexual behaviour followed by service providers judging from values of most indicators. The kind of alcohol consumption variables correlated with risky sexual behaviour variables, varied by occupation. Frequent alcohol consumption, higher AUDIT score, having got drunk, longer drinking hours and drinking any day of the week were strongly correlated with engaging in transactional sex among fishermen but fewer of the factors exhibited the same correlation among traders and service providers. Fishermen who drank 2 or more times a week were 7.9 times more likely to have had transactional sex (95% CI: 2.05-30.24) compared to those who never drank alcohol. A similar pattern was observed for traders and service providers at the landing sites. Inconsistent condom use or none use of condoms was not significantly correlated with any of the alcohol consumption indicator variables in multivariate analysis except for day of drinking among men.Item Alcohol use before sex and HIV acquisition: a longitudinal study in Rakai, Uganda(Aids, 2006) Zablotska, Iryna B.; Gray, Ronald H.; Serwadda, David; Nalugoda, Fred; Kigozi, Godfrey; Sewankambo, Nelson; Lutalo, Tom; Wabwire-Mangen, Fred; Wawer, MariaAlcohol abuse is a major public health problem and is associated with sexually transmitted infections, but the association with HIV is unclear [2]. Alcohol use is common, and disinhibition as a result of alcohol may precipitate and reinforce sexual risk-taking [2–13]. Two cross-sectional studies in Uganda have suggested associations between alcohol use, risk behaviors and prevalent HIV infection [12,14]. However, there are no prospective studies of alcohol use in conjunction with sex and HIV acquisition. We used data from a population based cohort in Rakai, Uganda, to determine whether alcohol use before sex was associated with the risk of HIV acquisition, and risk behaviors.Item Alcohol Use, Intimate Partner Violence, Sexual Coercion and HIV among Women Aged 15–24 in Rakai, Uganda(AIDS and Behavior, 2009) Zablotska, Iryna B.; Gray, Ronald H.; Koenig, Michael A.; Serwadda, David; Nalugoda, Fred; Kigozi, Godfrey; Sewankambo, Nelson; Lutalo, Tom; Wabwire-Mangen, Fred; Wawer, MariaDisinhibition due to alcohol may induce intimate partner violence and sexual coercion and increased risk of HIV infection. In a sample of 3,422 women aged 15–24 from the Rakai cohort, Uganda, we examined the association between self-reported alcohol use before sex, physical violence/sexual coercion in the past and prevalent HIV, using adjusted odds ratios (Adj OR) and 95% confidence intervals (95% CI). During the previous year, physical violence (26.9%) and sexual coercion (13.4%) were common, and alcohol use before sex was associated with a higher risk of physical violence/sexual coercion. HIV prevalence was significantly higher with alcohol consumption before sex (Adj OR = 1.45, 95% CI: 1.06– 1.98) and especially when women reported both prior sexual coercion and alcohol use before sex (Adj OR = 1.79, 95% CI: 1.25–2.56). Alcohol use before sex was associated with physical violence and sexual coercion, and both are jointly associated with HIV infection risk inItem Client and Provider Perspectives of the Efficiency and Quality of Care in the Context of Rapid Scale-Up of Antiretroviral Therapy(AIDS patient care and STDs, 2010) Amanyire, Gideon; Wanyenze, Rhoda K.; Alamo, Stella; Kwarisiima, Dalsone; Sunday, Pamela; Sebikaari, Gloria; Kamya, Moses; Wabwire-Mangen, Fred; Wagner, GlennGlobal scale-up of antiretroviral therapy (ART) has focused on clinical outcomes with little attention on its impact on existing health systems. In June–August 2008, we conducted a formative evaluation on ART scale-up and clinic operations at three clinics in Uganda to generate lessons for informing policy and larger public health care systems. Site visits and semistructured interviews with 10 ART clients and 6 providers at each clinic were used to examine efficiency of clinic operations (patient flow, staff allocation to appropriate duties, scheduling of clinic visits, record management) and quality of care (attending to both client and provider needs, and providing support for treatment adherence and retention). Clients reported long waiting times but otherwise general satisfaction with the quality of care. Providers reported good patient adherence and retention, and support mechanisms for clients. Like clients, providers mentioned long waiting times and high workload as major challenges to clinic expansion. Providers called for more human resources and stress-release mechanisms to prevent staff burnout. Both providers and clients perceive these clinics to be delivering good quality care, despite the recognition of congested clinics and long waiting times. These findings highlight the need to address clinic efficiency as well as support for providers in the context of rapid scale-up.Item Coercive sex in rural Uganda: Prevalence and associated risk factors(Social Science & Medicine, 2004) Koenig, Michael A.; Lutalo, Tom; Zhao, Feng; Nalugoda, Fred; Kiwanuka, Noah; Wabwire-Mangen, Fred; Kigozi, Godfrey; Sewankambo, Nelson; Wagman, Jennifer; Serwadda, David; Wawer, Maria; Gray, RonaldDespite growing recognition of the problem, relatively little is known about the issue of coercive sex in developing countries. This study presents findings from a community-based survey of 4279 reproductive-aged women in current partnerships in the Rakai District of Uganda carried out in 1998–99. One in four women in our study report having experienced coercive sex with their current male partner, with most women reporting its occasional occurrence. In a regression analysis of risk factors for coercive sex, conventional socio-demographic characteristics emerged as largely unpredictive of the risk of coercive sex. Behavioral risk factors—most notably, younger age of women at first intercourse and alcohol consumption before sex by the male partner—were strongly and positively related to the risk of coercive sex. Coercive sex was also strongly related to perceptions of the male partner’s HIV risk, with women who perceived their partner to be at highest risk experiencing almost three times the risk of coercive sex relative to low risk partnerships. Supplemental analysis of 1-year longitudinal data provides additional support for the hypothesis that coercive sex may frequently be a consequence of women’s perceptions of increased HIV risk for their male partner. The findings of this study are discussed in terms of the need for sexual violence prevention programs more generally in settings such as Uganda, and in terms of the possible importance of incorporating issues of sexual and physical violence within current HIV prevention programs.Item Contraceptive Use in Women Enrolled into Preventive HIV Vaccine Trials: Experience from a Phase I/II Trial in East Africa(PLoS ONE, 2009) Kibuuka, Hannah; Guwatudde, David; Kimutai, Robert; Maganga, Lucas; Maboko, Leonard; Watyema, Cecilia; Sawe, Fredrick; Shaffer, Douglas; Matsiko, Dickson; Millard, Monica; Michael, Nelson; Wabwire-Mangen, Fred; Robb, MerlinHIV vaccine trials generally require that pregnant women are excluded from participation, and contraceptive methods must be used to prevent pregnancy during the trial. However, access to quality services and misconceptions associated with contraceptive methods may impact on their effective use in developing countries. We describe the pattern of contraceptive use in a multi-site phase I/IIa HIV Vaccine trial in East Africa (Uganda, Kenya and Tanzania) and factors that may have influenced their use during the trial. Methods: Pregnancy prevention counseling was provided to female participants during informed consent process and at each study visit. Participants’ methods of contraception used were documented. Methods of contraceptives were provided on site. Pregnancy testing was done at designated visits during the trial. Obstacles to contraceptive use were identified and addressed at each visit. Results: Overall, 103 (31.8%) of a total of 324 enrolled volunteers were females. Female participants were generally young with a mean age of 29(67.2), married (49.5%) and had less than high school education (62.1%). Hormonal contraceptives were the most common method of contraception (58.3%) followed by condom use (22.3%). The distribution of methods of contraception among the three sites was similar except for more condom use and less abstinence in Uganda. The majority of women (85.4%) reported to contraceptive use prior to screening. The reasons for not using contraception included access to quality services, insufficient knowledge of certain methods, and misconceptions. Conclusion: Although hormonal contraceptives were frequently used by females participating in the vaccine trial, misconceptions and their incorrect use might have led to inconsistent use resulting in undesired pregnancies. The study underscores the need for an integrated approach to pregnancy prevention counseling during HIV vaccine trials.Item Correlates of previous couples’ HIV counseling and testing uptake among married individuals in three HIV prevalence strata in Rakai, Uganda(Global health action, 2015) Matovu, Joseph K.B.; Todd, Jim; Wanyenze, Rhoda K.; Wabwire-Mangen, Fred; Serwadda, DavidStudies show that uptake of couples’ HIV counseling and testing (couples’ HCT) can be affected by individual, relationship, and socioeconomic factors. However, while couples’ HCT uptake can also be affected by background HIV prevalence and awareness of the existence of couples’ HCT services, this is yet to be documented. We explored the correlates of previous couples’ HCT uptake among married individuals in a rural Ugandan district with differing HIV prevalence levels. Design: This was a cross-sectional study conducted among 2,135 married individuals resident in the three HIV prevalence strata (low HIV prevalence: 9.7 11.2%; middle HIV prevalence: 11.4 16.4%; and high HIV prevalence: 20.5 43%) in Rakai district, southwestern Uganda, between November 2013 and February 2014. Data were collected on sociodemographic and behavioral characteristics, including previous receipt of couples’ HCT. HIV testing data were obtained from the Rakai Community Cohort Study. We conducted multivariable logistic regression analysis to identify correlates that are independently associated with previous receipt of couples’ HCT. Data analysis was conducted using STATA (statistical software, version 11.2). Results: Of the 2,135 married individuals enrolled, the majority (n 1,783, 83.5%) had been married for five or more years while (n 1,460, 66%) were in the first-order of marriage. Ever receipt of HCT was almost universal (n 2,020, 95%); of those ever tested, (n 846, 41.9%) reported that they had ever received couples’ HCT. There was no significant difference in previous receipt of couples’ HCT between low (n 309, 43.9%), middle (n 295, 41.7%), and high (n 242, 39.7%) HIV prevalence settings (p 0.61). Marital order was not significantly associated with previous receipt of couples’ HCT. However, marital duration [five or more years vis-a`-vis 1 2 years: adjusted odds ratio (aOR): 1.06; 95% confidence interval (95% CI): 1.04 1.08] and awareness about the existence of couples’ HCT services within the Rakai community cohort (aOR: 7.58; 95% CI: 5.63 10.20) were significantly associated with previous receipt of couples’ HCT.Item Determinants of HIV-1 Load in Subjects with Early and Later HIV Infections, in a General-Population Cohort of Rakai, Uganda(Journal of Infectious Diseases, 2004) Gray, Ronald H.; Li, X.; Wawer, Maria J.; Serwadda, David; Sewankambo, Nelson K.; Wabwire-Mangen, Fred; Lutalo, Tom; Kiwanuka, Noah; Kigozi, Godfrey; Nalugoda, Fred; Meehan, Mary P.; Quinn, Thomas C.Human immunodeficiency virus (HIV) type 1 RNA loads were determined for 256 subjects with early (incident) HIV infection and for 1293 subjects with later (prevalent) HIV infection, in a Ugandan cohort. Prevalent infections were classified as latent (0–1 symptoms) and midstage disease ( 2 symptoms), and deaths were ascribed to acquired immunodeficiency syndrome. Among subjects with incident HIV infection, HIV load did not differ by sex, but, among subjects with prevalent HIV infection, it was higher in males than in females. HIV load was highest in subjects (25–29 years old) with incident HIV infection but increased with age in subjects with prevalent HIV infection. Viremia was higher after serconversion than in latency and increased with more advanced disease. Viremia was increased with genital ulcer disease (GUD) in both subjects with incident infection and in those with prevalent infection, and with herpes simplex virus type 2 seropositivity in subjects with incident HIV infection. GUD was consistently associated with higher HIV loads in subjects with incident and those with prevalent HIV infection, suggesting that treatment of GUD might reduce HIV viremia.Item Domestic violence in rural Uganda: evidence from a community-based study(Bulletin of the world health organization, 2003) Koenig, Michael A.; Lutalo, Tom; Zhao, Feng; Nalugoda, Fred; Wabwire-Mangen, Fred; Kiwanuka, Noah; Wagman, Jennifer; Serwadda, David; Wawer, Maria; Gray, RonaldAlthough domestic violence is an increasing public health concern in developing countries, evidence from representative, community-based studies is limited. In a survey of 5109 women of reproductive age in the Rakai District of Uganda, 30% of women had experienced physical threats or physical abuse from their current partner—20% during the year before the survey. Three of five women who reported recent physical threats or abuse reported three or more specific acts of violence during the preceding year, and just under a half reported injuries as a result. Analysis of risk factors highlights the pivotal roles of the male partner’s alcohol consumption and his perceived human immunodeficiency virus (HIV) risk in increasing the risk of male against female domestic violence. Most respondents —70% of men and 90% of women—viewed beating of the wife or female partner as justifiable in some circumstances, posing a central challenge to preventing violence in such settings.Item The effects of male circumcision on female partners’ genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda(American journal of obstetrics and gynecology, 2009) Gray, Ronald H.; Kigozi, Godfrey; Serwadda, David; Makumbi, Fredrick; Nalugoda, Fred; Watya, Stephen; Moulton, Laurence; Cheng, Michael Z.; Sewankambo, Nelson K.; Kiwanuka, Noah; Sempijja, Victor; Lutalo, Tom; Kagayii, Joseph; Wabwire-Mangen, Fred; Ridzon, Renée; Bacon, Melanie; Wawer, Maria J.The objective of the study was to assess effects of male circumcision on female genital symptoms and vaginal infections. STUDY DESIGN: Human immunodeficiency virus (HIV)-negative men enrolled in a trial were randomized to immediate or delayed circumcision (control arm). Genital symptoms, bacterial vaginosis (BV), and trichomonas were assessed in HIV-negative wives of married participants. Adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CIs) were assessed by multivariable log-binomial regression, intent-to-treat analyses. RESULTS: A total of 783 wives of control and 825 wives of intervention arm men were comparable at enrollment. BV at enrollment was higher in control (38.3%) than intervention arm spouses (30.5%, P .001). At 1 year follow-up, intervention arm wives reported lower rates of genital ulceration (adjPRR, 0.78; 95% CI, 0.63-0.97), but there were no differences in vaginal discharge or dysuria. The risk of trichomonas was reduced in intervention arm wives (adjPRR, 0.52; 95% CI, 0.05- 0.98), as were the risks of any BV (adjPRR, 0.60; 95% CI, 0.38-0.94) and severe BV (prevalence risk ratios, 0.39; 95% CI, 0.24-0.64). CONCLUSION: Male circumcision reduces the risk of ulceration, trichomonas, and BV in female partners.Item Effects of Medical Male Circumcision (MC) on Plasma HIV Viral Load in HIV+ HAART Nai¨ve Men; Rakai, Uganda(PLoS ONE, 2014) Kigozi, Godfrey; Musoke, Richard; Kighoma, Nehemiah; Watya, Stephen; Serwadda, David; Nalugoda, Fred; Kiwanuka, Noah; Wabwire-Mangen, Fred; Tobian, Aaron; Makumbi, Fredrick; Galiwango, Ronald Moses; Sewankambo, Nelson; Nkale, James; Kigozi Nalwoga, Grace; Anyokorit, Margaret; Lutalo, Tom; Henry Gray, Ronald; Wawer, Maria JoanMedical male circumcision (MC) of HIV-infected men may increase plasma HIV viral load and place female partners at risk of infection. We assessed the effect of MC on plasma HIV viral load in HIV-infected men in Rakai, Uganda. 195 consenting HIV-positive, HAART naı¨ve men aged 12 and above provided blood for plasma HIV viral load testing before surgery and weekly for six weeks and at 2 and 3 months post surgery. Data were also collected on baseline social demographic characteristics and CD4 counts. Change in log10 plasma viral load between baseline and follow-up visits was estimated using paired t tests and multivariate generalized estimating equation (GEE).Item Electronic Medical Records and Same Day Patient Tracing Improves Clinic Efficiency and Adherence to Appointments in a Community Based HIV/AIDS Care Program, in Uganda(AIDS and Behavior, 2012) Alamo, Stella T.; Wagner, Glenn J.; Sunday, Pamela ,; Wanyenze, Rhoda K.; Ouma, Joseph; Kamya, Moses; Colebunders, Robert; Wabwire-Mangen, FredPatients who miss clinic appointments make unscheduled visits which compromise the ability to plan for and deliver quality care. We implemented Electronic Medical Records (EMR) and same day patient tracing to minimize missed appointments in a community-based HIV clinic in Kampala. Missed, early, on-schedule appointments and waiting times were evaluated before (pre- EMR) and 6 months after implementation of EMR and patient tracing (post-EMR). Reasons for missed appointments were documented pre and post-EMR. The mean daily number of missed appointments significantly reduced from 21 pre-EMR to 8 post-EMR. The main reason for missed appointments was forgetting (37%) but reduced significantly by 30% post-EMR. Loss to followup (LTFU) also significantly decreased from 10.9 to 4.8% The total median waiting time to see providers significantly decreased from 291 to 94 min. Our findings suggest that EMR and same day patient tracing can significantly reduce missed appointments, and LTFU and improve clinic efficiency.Item Elevated Natural Killer Cell Activity Despite Altered Functional and Phenotypic Profile in Ugandans With HIV-1 Clade A or Clade D Infection(JAIDS Journal of Acquired Immune Deficiency Syndromes, 2009) Eller, Michael A.; Eller, Leigh Anne; Ouma, Benson J.; Thelian, Doris; Gonzalez, Veronica D.; Guwatudde, David; McCutchan, Francine E.; Marovich, Mary A.; Michael, Nelson L.; Souza, Mark S. de; Wabwire-Mangen, Fred; Robb, Merlin L.; Currier, Jeffrey R.; Sandberg, Johan K.Natural killer (NK) cells most likely contribute toward limiting HIV-1 replication, and investigation into their function throughout the course of infection is therefore important. We here aimed to determine the state of the NK cell compartment in Ugandans with untreated HIV-1 clade A or D infection in comparison with matched uninfected controls. Methods and Results: The function and phenotype of NK cells were investigated using 10-color flow cytometry. Surprisingly, NK cells displayed elevated production of interferon-g and macrophage inflammatory protein 1b, as well as CD107a degranulation in infected subjects. This included unexpected levels of degranulation in the CD56bright subset of NK cells and high levels of macrophage inflammatory protein 1b in CD56negative NK cells. HIV-1 infection was associated with reduced expression of KIR2DL1, NKG2A, CD161, and NKp30 in CD56dim and CD56negative NK cells, whereas lowered CD161 expression was the only alteration in the CD56bright subset. Interestingly, low CD4 counts were associated with increased levels of interferon-g and degranulation in CD56bright NK cells, as well as increased NKp44 expression in the CD56dim cells. NK cells in HIV-1–infected Ugandans display elevated activity, despite an altered functional and phenotypic profile. Furthermore, specific alterations in the CD56bright and CD56dim subsets occur in patients with severe CD4 loss.Item Epidemiology and Surveillance of Influenza Viruses in Uganda between 2008 and 2014(PLoS ONE, 2016) Wabwire-Mangen, Fred; Mimbe, Derrick E.; Erima, Bernard; Mworozi, Edison A.; Millard, Monica; Kibuuka, Hannah; Lukwago, Luswa; Bwogi, Josephine; Kiconco, Jocelyn; Tugume, Titus; Mulei, Sophia; Ikomera, Christine; Tsui, Sharon; Malinzi, Stephen; Kasasa, Simon; Coldren, Rodney; Byarugaba, Denis K.Influenza surveillance was conducted in Uganda from October 2008 to December 2014 to identify and understand the epidemiology of circulating influenza strains in out-patient clinic attendees with influenza-like illness and inform control strategies. Methodology Surveillance was conducted at five hospital-based sentinel sites. Nasopharyngeal and/or oropharyngeal samples, epidemiological and clinical data were collected from enrolled patients. Real-time reverse transcription polymerase chain reaction (RT-PCR) was performed to identify and subtype influenza strains. Data were double-entered into an Epi Info 3.5.3 database and exported to STATA 13.0 software for analysis. Results Of the 6,628 patient samples tested, influenza virus infection was detected in 10.4% (n = 687/ 6,628) of the specimens. Several trends were observed: influenza circulates throughout the year with two peaks; the major one from September to November and a minor one from March to June. The predominant strains of influenza varied over the years: Seasonal Influenza A(H3) virus was predominant from 2008 to 2009 and from 2012 to 2014; Influenza A (H1N1)pdm01 was dominant in 2010; and Influenza B virus was dominant in 2011. The peaks generally coincided with times of higher humidity, lower temperature, and higher rainfall. Conclusion Influenza circulated throughout the year in Uganda with two major peaks of outbreaks with similar strains circulating elsewhere in the region. Data on the circulating strains of influenza and its patterns of occurrence provided critical insights to informing the design and timing of influenza vaccines for influenza prevention in tropical regions of sub-Saharan Africa.Item Fertility and contraceptive decision-making and support for HIV infected individuals: client and provider experiences and perceptions at two HIV clinics in Uganda(BMC public health, 2013) Wanyenze, Rhoda K.; Wagner, Glenn J.; Tumwesigye, Nazarius M.; Nannyonga, Maria; Wabwire-Mangen, Fred; Kamya, Moses R.Some people living with HIV/AIDS (PLHIV) want to have children while others want to prevent pregnancies; this calls for comprehensive services to address both needs. This study explored decisions to have or not to have children and contraceptive preferences among PLHIV at two clinics in Uganda. Methods: This was a qualitative cross-sectional study. We conducted seventeen focus group discussions and 14 in-depth interviews with sexually active adult men and women and adolescent girls and boys, and eight key informant interviews with providers. Overall, 106 individuals participated in the interviews; including 84 clients through focus group discussions. Qualitative latent content analysis technique was used, guided by key study questions and objectives. A coding system was developed before the transcripts were examined. Codes were grouped into categories and then themes and subthemes further identified. Results: In terms of contraceptive preferences, clients had a wide range of preferences; whereas some did not like condoms, pills and injectables, others preferred these methods. Fears of complications were raised mainly about pills and injectables while cost of the methods was a major issue for the injectables, implants and intrauterine devices. Other than HIV sero-discordance and ill health (which was cited as transient), the decision to have children or not was largely influenced by socio-cultural factors. All adult men, women and adolescents noted the need to have children, preferably more than one. The major reasons for wanting more children for those who already had some were; the sex of the children (wanting to have both girls and boys and especially boys), desire for large families, pressure from family, and getting new partners. Providers were supportive of the decision to have children, especially for those who did not have any child at all, but some clients cited negative experiences with providers and information gaps for those who wanted to have children. Conclusions: These findings show the need to expand family planning services for PLHIV to provide more contraceptive options and information as well as expand support for those who want to have children.Item Genetic analysis of influenza B viruses isolated in Uganda during the 2009–2010 seasons(Virology Journal, 2013) Byarugaba, Denis K.; Erima, Bernard; Millard, Monica; Kibuuka, Hannah; Lukwago, L.; Bwogi, Josephine; Mimbe, Derrick; Mworozi, Edison A.; Sharp, Bridget; Krauss, Scott; Webby, Richard J.; Webster, Robert G.; Martin, Samuel K.; Wabwire-Mangen, Fred; Ducatez, Mariette F.Influenza B viruses can cause morbidity and mortality in humans but due to the lack of an animal reservoir are not associated with pandemics. Because of this, there is relatively limited genetic sequences available for influenza B viruses, especially from developing countries. Complete genome analysis of one influenza B virus and several gene segments of other influenza B viruses isolated from Uganda from May 2009 through December 2010 was therefore undertaken in this study. Methods: Samples were collected from patients showing influenza like illness and screened for influenza A and B by PCR. Influenza B viruses were isolated on Madin-Darby Canine Kidney cells and selected isolates were subsequently sequenced and analyzed phylogenetically.Item Health-related quality of life in epilepsy patients receiving anti-epileptic drugs at National Referral Hospitals in Uganda: a cross-sectional study(Health and Quality of Life Outcomes, 2014) Nabukenya, Anne M.; Matovu, Joseph K. B.; Wabwire-Mangen, Fred; Wanyenze, Rhoda K.; Makumbi, FredrickEpilepsy is a devastating disorder that impacts on patients’ quality of life, irrespective of use of anti epileptic drugs (AEDs). This study estimates the health-related quality of life (HRQOL) and its associated predictors among epilepsy patients receiving AEDs. Methods: A total of 175 epilepsy patients already receiving AED for at least 3 months were randomly selected and interviewed from mental clinics at Mulago and Butabika national referral hospitals in Uganda between May - July 2011. A HRQOL index, the primary outcome, was constructed using items from Quality Of Life in Epilepsy Inventory (QOLIE-31) and the Hospital Anxiety and Depression Scale (HADS) questionnaires. The internal consistency and adequacy of these items was also computed using Cronbach's alpha and Kaiser-Meyer-Olkin tests. Partial correlations were used to evaluate the contribution of the health dimensions (mental, psychological, social, physical functioning and emotional well being) and, multiple linear regressions to determine factors independently associated with HRQOL. Results: Just about half of the respondents (54%) were males, and nearly two thirds (62%) had received AEDs for at least 12 months. The average age was 26.6 years (SD = 11.1). The overall HRQOL mean score was 58 (SD = 13) on a scale of 0–100. The average scores of different dimensions or subscales ranged from 41 (physical) to 65 (psychological). At least three quarters (75%) of all subscales had good internal consistency and adequacy. The largest variations in the overall HRQOL were explained by social and mental functioning; each accounting for about 30% of the difference in the HRQOL but seizure control features explained a little (6%) variation. Factors negatively associated with HRQOL were poly-therapy (−1.16, p = 0.01) and frequency of seizures (−2.29, p = 0.00). Other factors associated with overall HRQOL included drug side effects, sex, marital status and education. Duration on AEDs was not a significant predictor of HRQOL. Conclusion: The HRQOL for epilepsy patients on AEDs is very low. The predictors of low HRQOL were socio factors (marital status, education) and drug side effects, frequency of seizure, and type of therapy.